| NPI | 1801337373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33816) |
| Additional Taxonomies | 111NR0400X (Licence: CA 33816) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA 33816) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA 33816) | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |